Supreme Court questions whether the HHS Secretary has legal authority to appoint Preventive Services Task Force members in a case that could unravel key Affordable Care Act provisions.
At a Glance
- Supreme Court is examining whether the US Preventive Services Task Force (USPSTF) appointments violate constitutional requirements
- The case challenges the legal foundation of ACA’s preventive services coverage mandate
- The Court specifically questioned whether the HHS Secretary’s appointment power derives from proper statutory authority
- A ruling against the government could eliminate requirements for insurers to cover many preventive services without cost-sharing
- Decision expected by June 2025 could affect access to services like cancer screenings and preventive medications
Constitutional Challenge to Obamacare Preventive Services
The Supreme Court is hearing oral arguments in Kennedy v. Braidwood Management, a case that strikes at the heart of the Affordable Care Act’s preventive services requirements. The lawsuit, scheduled for April 21, 2025, challenges whether the US Preventive Services Task Force’s structure violates the Constitution’s Appointments Clause. At issue is Section 2713 of the ACA, which mandates that health insurance plans cover preventive services without cost-sharing based on recommendations from entities including the USPSTF.
The plaintiffs, including Braidwood Management (described as a “Christian professional association”), originally filed suit in 2022, claiming these requirements were unconstitutional. The District Court initially ruled in their favor, finding that USPSTF appointments violated constitutional requirements and that requiring coverage of HIV-prevention medication PrEP violated the Religious Freedom Restoration Act. The 5th Circuit Court of Appeals affirmed the ruling against USPSTF but limited the remedy to the plaintiffs rather than imposing a nationwide injunction.
The Appointments Clause Question
At the core of this case is whether USPSTF members should be considered “officers of the United States” under the Constitution’s Appointments Clause. If they are, their appointments must follow specific constitutional procedures. Braidwood argues that USPSTF members exercise significant authority as officers of the United States and should therefore be appointed by the president with Senate confirmation. The federal government counters that the HHS Secretary maintains sufficient oversight, making Task Force members “inferior officers” whose appointments comply with constitutional requirements.
“In addition to removing Task Force members at will, the Secretary may supervise and review their recommendations directly,” argued the Trump Administration’s HHS during earlier proceedings.
Supreme Court Probes Statutory Authority
In a significant development, the Supreme Court has requested supplemental briefing on a critical question: “Whether Congress has ‘by Law’ vested the Secretary of the Department of Health and Human Services with the authority to appoint members of the United States Preventive Services Task Force.” This suggests the Court may be exploring whether the Secretary’s appointment power has proper statutory foundation, rather than just examining constitutional requirements.
During oral arguments, Justice Thomas directly questioned the government’s legal basis for these appointments, asking: “Before we get to the constitutional problems, what’s the statutory authority to appoint the Task Force?”
The government’s response pointed to the Reorganization Plan No. 3 of 1966, which is not itself a statute passed through traditional legislative means. Instead, this plan resulted from the 1949 Reorganization Act, which allowed presidents to transmit reorganization plans to Congress that would take effect unless both Houses passed a resolution of disapproval.
Historical Context and Legal Implications
The Court has specifically directed parties to address two historical cases: United States v. Hartwell (1868) and United States v. Smith (1888). These cases help establish whether statutory authority is required for appointing officers. The government argues that the 1984 Act ratified all reorganization plans as law, effectively making the 1966 Plan a statute, but this interpretation remains contentious.
Potential Impact on Healthcare Coverage
A ruling in Braidwood’s favor could significantly impact healthcare access for millions of Americans. If the Court finds the USPSTF appointments unconstitutional, insurers may no longer be required to cover USPSTF-recommended preventive services without cost-sharing. This could affect access to crucial services like cancer screenings, statins for heart disease prevention, and HIV-prevention medication, potentially leading to increased out-of-pocket costs for patients.
The Court’s decision, expected by June 2025, may not be the final word on preventive service coverage requirements. Congress could respond with new legislation, or the administration might restructure the USPSTF to comply with constitutional requirements. For now, Americans with private insurance face uncertainty about whether important preventive health services will remain fully covered in the future.
